American Dance Training Camp
The ULTIMATE Overnight Dance Camp!
Phone/Fax: (866) 383-ADTC Email: ADTC@ASDance.com
CA HEALTH FORMS & WAIVERS
Follow the directions below for completing and submitting the required health forms & waivers:
1. Read the sections on the back of this page regarding ADTC’s health policies and procedures.
2. Complete the following forms online:
• Form 1a: “Health History - Camper Info”
• Form 1b: “Health History - Immunization History & Medications”
• Form 4: “Canteen / Activity Account Set-Up”
• Form 5: “Roommate Requests & Personal History”
• Form 6: “Authorized Release To, and From”
3. Print & complete (sign where indicated) the attached forms, waivers and tasks, then either upload
online, email to ADTC@ASDance.com or fax to 866-383-ADTC:
• Form 2: “Health-Care Recommendations by Licensed Medical Personnel” (Have your physician return this
form to you – DO NOT ask them to send it to ADTC directly)
• Form 3: “ADTC Optional Activities Participation Release of Liability & Assumption of Risk Agreement”
• Forms 3a, 3b, 3c, etc. (only if your camper has your permission to choose to participate in these activities)
• Form 7: “Releases & Agreements”
• Photocopy BOTH THE FRONT AND BACK of the insurance card covering the camper
4. COMPLETE & SUBMIT FORMS & PHOTOCOPIES (STEPS 1-3) TO ADTC BY JUNE 15, 2009
Accepted ways to submit attached printed forms &
photocopies (#3) by June 15:
Upload Online (preferred!):
Email To: ADTC@ASDance.com
Fax To: 866-383-ADTC
ADTC HEALTH POLICIES & PROCEDURES
** Please read before completing health forms **
Camper Physical Examination
A physical examination is necessary to attend camp. The physical must be within two years of camper’s attendance.
The enclosed Form 2b MUST be completed by a licensed physician and you. Any special directions from your physician should be listed on
this form. Remember to sign ALL areas requiring a signature. Your child will not be able to participate if any health form is incomplete.
ADTC is not responsible if a camper is unable to participate due to an incomplete health form. All of the attached forms must be submitted
to ADTC by June 15, 2009.
All campers must have medical insurance to attend camp. Your personal medical policy is your child’s primary coverage. If a camper sustains
an injury at camp, parents are required to pay for any out-of-pocket expenses and then submit the claim to their insurance company. Parents
are responsible for paying all physician’s fees and prescription costs incurred by their child.
Parents must make clear any psychiatric problem or other serious medical problem on their child’s health forms. In fairness to our counselors,
staff and campers, we need to make informed decisions regarding the care of every child. Therefore, the camp directors also need to know if
a camper is experiencing traumatic reactions to family issues such as parental separation, divorce or death. Our purpose in having pertinent
health information, both physical and emotional, is to be able to better serve each child. We expect that parents or guardians of any child sent
to ADTC have provided us with all the necessary information for a positive camp experience.
The directors of ADTC must reserve the right to ask that a child potentially at risk to herself or the camp community be picked up and removed
from camp immediately. There may be a circumstance where we have agreed to accept a child with full knowledge of her problems and have
attempted to take all the necessary steps to make the experience successful, but find that it is not possible to do so. For the good of this child
and/or the camp community, the child may have to leave.
Health and First Aid Staffing
ADTC’s Health Care Manager shall be a Physician (MD), Registered Nurse (RN), Licensed Practical Nurse (LPN), or Emergency Medical
Technician (EMT) with a valid license as well as CPR certification. The Health Care Manager will remain on-call throughout each session and
visit the camp daily. In the Health Care Manager’s absence, all health related issues will be covered by the Program Director or other ADTC
staff as assigned by the Program Director. ADTC staff are trained in basic first aid and CPR, and our counselors are well-versed in handling
In the event that a camper needs immediate medical attention, she will be taken by ADTC nurse, director or ambulance to the Tahoe Forest
Hospital in Truckee, five miles away. There is also a paramedics/ fire station 1 ! miles away on Squaw Valley Rd.
All campers will be screened for general health by the Health Care Manager or Program Director upon their arrival at camp. The Health Care
Manager shall register temperatures and look for signs of physical abuse, head lice and illness. Observations shall be recorded in the Health
Log and noted on the camper’s medical form.
Storage of Medications and Prescription Drugs
All meds (prescription and non-prescription) for campers must be turned in to the Health Care Manager. Meds must be in the original
container with dosage and frequency clearly marked, stored in a locked container. The Health Care Manager or Program Director is
responsible for keeping all medications secure, including medications that must be refrigerated. The Health Care Manager or Program
Director may make specific exceptions to this policy as required.
Administration of Medications and Prescription Drugs
Medications must be administered by an ADTC staff member while your camper is at ADTC. Complete the enclosed section for medications
being taken (Form 1b). We will also have “Medical Administration” forms available to be completed at check-in. The Health Care Manager or
Program Director will bring medications to meals and dispense them; counselors will send their campers to the Health Care Manager or
Program Director for bedtime medications. Any medications not picked up when your child checks out of camp will be disposed of the week
after your child’s departure.
Managing Food Allergies &/or Dietary Restrictions
Parents of campers with serious food allergies or dietary restrictions should plan to speak with the cook &/or nurse during check-in for their
session. Please note that you are encouraged to purchase and bring to camp any desired or necessary food items for your camper during her
stay with us. Special dietary items will be stored appropriately in the kitchen and served to your camper based on the schedule you discuss
with the kitchen staff. Under no circumstances should food be stored in a camper’s room without prior consent from the ADTC Program
Director. Should you wish to speak with the kitchen staff and/or nurse prior to arriving for check-in, please contact the ADTC office at 866-383-
2382, ext. 0 or email ADTC@ASDance.com.
Travel Off Camp Property
Accompanying staff are required to carry copies of the Camper Health Forms. A First Aid certified staff member will review contents of a First
Aid Kit with the Health Care Manager or Program Director, as well as any necessary medications. Any treatments or medication dispensed on
the trip will be recorded by the counselor in charge of the activity. The Health Care Manager will review the treatment log for any follow up that
should be done.
FORM 2: Health-Care Recommendations by Licensed Medical Personnel
Note: Copies of physical
examination forms from
health-care providers, schools
or state or local government
are acceptable; please attach
to this form.
FORM 3: ADTC OPTIONAL ACTIVITIES PARTICIPATION RELEASE OF
LIABILITY AND ASSUMPTION OF RISK AGREEMENT
** READ BEFORE SIGNING **
Please note that all optional activities below require parental consent and some require additional fees and/or additional waivers as indicated. Please check the
box for activities in which you give your child permission to participate – campers may only sign up for activities that you check and sign for here. Please Note:
Additional fees DO NOT APPLY if you purchased the “Unlimited Activities Pass” during registration.
! Ropes Course (Monday afternoon, weather permitting) - Built into the hillside facing beautiful Shirley Canyon and the world famous peaks of Squaw
Valley, this magnificent Ropes Course offers campers unparalleled teambuilding opportunities. Additional Waiver Required. Cost $40.
! Kayak Trip (Monday evening, weather permitting)
The staff at Tahoe City Kayak will take us for a leisurely paddle on beautiful Lake Tahoe. No prior canoeing/kayaking experience is required. Life
preservers provided. CAMPER MUST BE A SELF-SUFFICIENT SWIMMER! Additional Waiver Required. Cost $60
! Rock Wall (Tuesday &/or Friday afternoon) - No matter what the weather or your ability level, you’ll have a blast climbing the variety of routes and 30’
high simulated rock surface at the Headwall Climbing Wall. Comprising 8 to 10 different ropes and many routes, Headwall is suitable for kids, first timers
of all ages, and expert climbers Additional Waiver Required. Cost $16.
! Sky Jump Trampoline (Monday &/or Wednesday afternoon, weather permitting) - Hook the bungees to your harness - start jumping on the
trampolines - and soon you're soaring 25' in the air while performing somersaults and flips. Everyone wears a safety harness and is connected to a
rope/bungee system for safety. This bungee trampoline activity is sure to send every camper to new heights and keep the kids smiling for hours.
Additional Waiver Required. Cost $10.
! Mini Golf (Monday &/or Wednesday (Wednesday, Thursday &/or Friday afternoon, weather permitting) - Mountainside Mini Golf at the base of
Squaw Valley has eighteen holds – right in the village! Cost $10.
! High Camp – Ice Skating & Swimming (Tuesday &/or Thursday afternoon, weather permitting) - Yes, you can do both in the same spot! Ride the
scenic Squaw Valley Cable Car up to High Camp where you can both ice skate, and take a swim overlooking the entire Tahoe basin. Spend the
afternoon enjoying activities, food and breathtaking views. Cost $25.
! Horseback Riding (Wednesday &/or Friday afternoon, weather permitting) - Take an easy one-hour trail ride through the scenic woods surrounding
Squaw Valley, lead by the professionals at Squaw Valley Stables. No prior riding experience is required. Helmets and basic riding instruction are
provided. Registrants will be assigned to a day. Additional Waiver Required. Cost $35.
! World Dance Company For “Save the Children” (Mon. – Thurs. evenings, subject to availability/offerings) - Campers can elect to participate in
our unique “world dance company” and learn a special dance piece to perform in the Friday night show. Nightly rehearsals will be held from 9 – 9:55pm
beginning Monday after the all-camp “world dance night.” Participation is optional and campers who participate receive a certificate of global awareness.
All proceeds go to a “Save the Children” or similar program chosen by the company members that is specific to the area of the world the dance piece is
from. Cost $15.
! Whitewater Rafting (Friday afternoon) – Led by Truckee River Raft Co.. Additional Waiver Required. Cost $35.
! Swimming (Daily, weather permitting) - In sunny weather, we’ll cool down at the Squaw Valley Lodge’s outdoor pool, or the beaches of beautiful Lake
Tahoe (no cost). CAMPER MUST BE A SELF-SUFFICIENT SWIMMER. No Cost.
! Hiking Trip (Daily, weather permitting) - Take a hike! We’ll take you on a leisurely hike up the mountain where you can admire the natural beauty of
the area and the breathtaking views. No Cost.
! Tennis (Daily, weather permitting) - Brush up your tennis game with an hour on one of the Squaw Valley Lodge’s outdoor tennis courts. No Cost.
I HAVE REQUESTED THE AMERICAN SCHOOL OF DANCE (DBA: AMERICAN DANCE TRAINING CAMP) ALLOW MY CHILD TO PARTICIPATE IN THE FIELD
TRIPS CHECKED ABOVE. IN CONSIDERATION OF BEING ALLOWED TO PARTICIPATE IN ANY WAY IN THESE ACTIVITIES, I THE UNDERSIGNED,
ACKNOWLEDGE, APPRECIATE, AND AGREE THAT:
1. The risk of injury from these activities is significant, including the potential for permanent paralysis and death.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF
THE RELEASEES or others, and assume full responsibility for my participation.
3. I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or
participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD
HARMLESS THE AMERICAN SCHOOL OF DANCE, LLC, its officers, officials, agents and/or employees, other participants, vendors,
advertisers, the United States, the States of Vermont, California, Colorado, North Carolina and Connecticut from any and all claims, demands,
losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property,
WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY AND UNDERSTAND ITS TERMS, UNDERSTAND THAT I
HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Signature of Camper: ___________________________________________________ Date: ______________
Printed Name of Camper: ___________________________________________________________________
Address of Camper:
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE
This is to certify that I, as the parent/guardian with legal responsibility for this participant, do consent and agree to her release as provided above of all the
Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability
incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE
RELEASEES, to the fullest extent permitted by law.
Signature of Parent/Guardian______________________________________________ Date:
Participating Minor’s Date of Birth: _________________________ Age: _______________
Form 3a: Kayak Trip Waiver
• Please complete this page if your daughter may choose to participate in this activity
• Please skip this page if your daughter WILL NOT participate in the Kayak Trip
Form 3b: Horseback Riding Waiver
* Please sign this waiver if your daughter may participate in this activity
* Please skip this page if your daughter WILL NOT participate in horseback riding
Form 3c: White Water Rafting Waiver
* Please complete this page if your daughter may choose to participate in this activity
Please skip this page if your daughter WILL NOT participate in the flying trapeze
TRUCKEE RIVER RAFT CO.
RENTAL AGREEMENT***READ BEFORE SIGNING***
Name of Responsible Person __________________________ Home Address ______________________________________
City_____________________ State__________ Zip Code_____________ Home Telephone ( )______________________
Local Telephone ( )_________________ Local Address____________________________________________________
Driver's License Number ________________________ State ___________ Expiration Date _________________________
In consideration of services to be received, the Undersigned/Responsible Person and All Participants (hereinafter
referred to as the "Customer"), for himself/herself or his/hers heirs and assigns, hereby releases the Concession and the
Concessionaire's Employees (hereinafter referred to as the "Company") from any liability for claims or lawsuits brought by
the Customer and arising out of the activities provided by the Company.
Acknowledgment of Risk(s), Assumption of Risk(s) and Responsibility, Release of Liability
Good Rules To Raft By, and Customer Acknowledgment of Per Person Pricing
ACKNOWLEDGMENT OF RISK(S): The Customer recognizes that there are inherent risk(s) in this type of activity,
including but not limited to the following: (1) Falling; (2) Cold weather-related injuries including hypothermia, frostnip and
frostbite; (3) Heat-related illnesses including heat exhaustion and heat stroke; (4) and "acts of nature" which may include
avalanche, rock fall, inclement weather, thunder and lightning, hail, severe and/or varied wind, temperature or weather
conditions; (5) River crossings, fjording, or travel including travel to or from the activity; (6) Risk(s) associated with the crossing,
climbing or down climbing of rock, snow, ice, water, and any other nature or manmade obstacle encountered during the activity;
(7) Equipment failure or Customer error; (8) Discharge of weapons; (9) Risk(s) typically associated with watercraft, including
change in waterflow or current, sub-merged, semisub-merged and overhanging objects which may or may not be visible,
capsizing, swamping or sinking of watercraft and resultant hypothermia or drowning; and/or (10) Attack by animals.
The Customer acknowledges that certain foreseeable and unforeseeable events can contribute to the unpredictability of the
activity; that no warranty of any kind, expressed or implied, is made as to the habits, disposition, suitability, nature or physical
condition of any animal; that personal property may be damaged or lost; and that the Customer should ask about other potential
hazards and recommended precautions and procedures (see Good Rules To Raft By). The Customer accepts that wearing a
U.S.C.G.-approved personal floatation device for waterbome activities is a basic safety precaution; and that the Customer may
suffer accidents or illness in remote places where there are no available medical facilities,
EXPRESS ASSUMPTION OF RISK(S) AND RESPONSIBILITY: In recognition of the inherent risk(s) of the
activity which the Customer and any other person and/or minor children for which the Customer is responsible will engage in,
the Customer confirms that the Customer is physically and mentally capable of participating in the activity and/or using the
equipment. The Customer participates willingly and voluntarily. The Customer assumes full responsibility for personal injury,
accidents or illness (including death), and any resultant expenses. The Customer also assumes full responsibility for damage to
or loss of the Customer's personal property as the result of any accident and/or incident that may occur. Furthermore, the
Customer assumes full responsibility for returning any and all equipment rented/provided to the Customer by the Company in
the same condition that the said equipment was rented/provided in, and agrees to take full financial responsibility for any and all
repair/replacement costs for the said equipment, based on the Company's reasonable assessment of the damage.
The Customer assumes the risk(s) of personal injury, accidents and/or illness, including but not limited to, sprains, torn
muscles and/or ligaments; fractured or broken bones, eye damage; cuts, wounds, scrapes, abrasions, and/or contusions;
dehydration, oxygen shortage (anoxia), exposure and/or altitude sickness; head, neck and/or spine injuries; animal or insect bite
or attack, injury caused by discharge of any weapon; shock, paralysis, drowning, including near drowning, and/or death; and
hereby acknowledges that during the activity, if the Customer experiences fatigue, chill and/or dizziness, it may diminish
Customer reaction time and increase the risk(s) of accident, injury, and/or damage to the rented/provided equipment.
COVENANT OF GOOD FAITH: The Customer recognizes that the Company, as a provider of goods and/or services,
will operate under a covenant of good faith and fair dealing, but that the Company may find it necessary to terminate the activity
at any time due to the forces of nature, medical necessities or other problems; and/or refuse or terminate the participation of any
and all Customers that the Company judges to be incapable of meeting the rigors or requirements of participating in the activity.
The Customer accepts the Company's right to take such actions for the safety of the Customer and/or others. The Customer
acknowledges that no guarantees have been made with respect to achieving objectives.
AUTHORIZATION: The Customer hereby authorizes any and all medical treatment deemed necessary in the event of any injury
while participating in the activity. The Customer either has the appropriate insurance or, in its absence, agrees to pay any and all
costs of rescue and/or medical services as may be incurred on the Customers) behalf. The Customer agrees that any film or
photographs of the Customer, as a participant, become the property of the Company and may be used for promotional and/or
RIVER RAFT RENTAL AGREEMENT CONTINUED
RELEASE: In consideration of services or property/equipment provided, the Customer and any person and/or minor child for which the
Customer is a parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns, due hereby realize: Tahoe
Sierra Recreation, Inc., its principles, directors, officers, agents, employees and volunteers, and each and every land owner, municipal and/or
governmental agency upon whose property an activity is conducted from is released of all liability and Customer waives any claim for
damage(s) arising from any cause whatsoever (except that which is the result of gross negligence).
The Customer is responsible for the Customer and any person and/or minor child for which the Customer is a parent, legal guardian or
otherwise responsible, and the equipment rented/provided. Rafting is a HAZARDOUS activity. The Customer understands and agrees that the
said rented/provided equipment remains the property of the Company, and failure of the Customer to return the said equipment to the address
from which it was obtained constitutes larceny by bailee and subjects the Customer to prosecution therefore.
The Customer agrees to pay the Company for any loss of or damage to said rented/provided equipment incurred while in the custody of the
Customer, and to maintain and repair the said equipment and return it to the Company in the same condition as when rented/provided.
The Customer hereby acknowledges that the Customer has examined the said equipment and accessory equipment and that said equipment
and accessory equipment are in good condition.
The Customer agrees to reimburse Company for all attorney fees, court costs, and any other expenses incurred by the Company to enforce
collection or to preserve or enforce Company's rights under this Agreement.
The Customer acknowledges that no medical, liability, collision or other insurance coverage is afforded by the Company to the
Customer, and/or any person and/or minor child for which the Customer is a parent, legal guardian or otherwise responsible in connection with
this Agreement and the use and possession of said equipment, accessory equipment, person property, and any shuttle busing provided by
Company and used by the Customer. Accordingly in the event that Customer and/or any person and/or minor child for which the Customer is
a parent, legal guardian or otherwise responsible and/or said equipment, accessory equipment, personal property and/or shuttle busing provided
by the Company may be involved in an accident/incident, then the Customer shall be liable for any claim for damage(s) or injuries arising out of
GOOD RULES TO RAFT BY: The Customer hereby acknowledges and agrees to adhere and cooperate with the following
rules listed below, also recognizing that these rules are guidelines and that the Customer and/or any person and/or minor child for
which the Customer is a parent, legal guardian or otherwise responsible is completely responsible for their actions:
(A) If the Customer has a problem with the raft and/or any type of emergency: (1) Pull the raft to the right side of the
river; (2) Everyone else stay with the raft; and (3) One person take a paddle, go up to the highway and stand with the
paddle up in the air. A Company Driver will see you and the Company will send an employee/employees to assist you.
(B) Everyone and everything will get wet. DO NOT TAKE PERSONAL PROPERTY THAT THE CUSTOMER DOES NOT
WANT TO GET WET!
(C) No infants.
(D) ABSOLUTELY NO GLASS!
(E) Rafts have no keel. A raft will tip over if mis-weighted. The Customer MUST PADDLE TO STEER THE RAFT. The
Customer MUST PADDLE AROUND ANY OBVIOUS OBSTACLES (i.e., rocks, logs, sticks, and supports for bridges).
(F) All persons should stay seated on the BLUE/GRAY areas of the raft (they provide an air cushion in the event that the Customer
gets stuck on an obstruction). If the Customer does get stuck on an obstruction: (1) STAY SEATED; (2) Bounce up and down (in a
seated position); (3) The Customer may need to change positions to redistribute the weight in the raft and then bounce again (in a
seated position); and (4) If the Customer must get out of the raft to free it from the obstacle, make sure you STAY UPSTREAM!
(G) DUCK AT ANY AND ALL LOW BRIDGES and/or OBSTACLES.
(H) PLEASE RESPECT ALL POSTED SIGNS, including but not limited to: "PRIVATE PROPERTY", "SENSITIVE AREAS",
and any type of sign, including but not limited to "REDUCED/RESTRICTED NOISE".
(I) There are Portable Bathrooms and Garbage Cans along the River. PLEASE USE THEM!
(J) ALWAYS WEAR YOUR LIFEVEST AND FOOTWEAR!
(K) When the Customer goes through any Rapid Section of the River They Must Paddle! After the GREEN BRIDGE, the
Customer will approach the LAST RAPID SECTION - YOU MUST WEAR YOUR LIFEVEST AND PADDLE HARD!!!!
CUSTOMER ACKNOWLEDGMENT OF PER PERSON PRICING: The service, equipment and goods provided the Customer by the Company
are provided to the Customer according to a per person price. The Customer hereby agrees to take full and complete personal responsibility
for any and all additional person(s) -who have not been paid for and are not listed below (with name and signature of said person(s) on this
Rental Agreement) hereinafter referred to as "Poachers " who are seen, observed, or photographed illegally utilizing the services, equipment,
transportation, or goods provided to the Customer by the Company, including but not limited to, the per person price owed to the Company for
each Poacher, as well as legal, criminal, and any and all liability remedies will be applied POACHING IS A CRIME (FRAUD) AND WILL NOT
I HAVE READ AND UNDERSTOOD THIS RENTAL AGREEMENT ENTIRELY, INCLUDING THE FOREGOING ACKNOWLEDGMENT OF RISK(S),
ASSUMPTION OF RISK(S) AND RESPONSIBILITY RELEASE OF LIABILITY, GOOD RULES TO RAFT BY, and CUSTOMER ACKNOWLEDGMENT OF PER
PERSON PRICING. I UNDERSTAND THAT BY SIGNING THIS AGREEMENT, I MAY BE WAIVING VALUABLE LEGAL RIGHTS.
Names of Minors; (Printed) Age(s)
Customer/Responsible Adult Signature
_________________________________________ ______ _______________________________________________________________________________
Form 3d: Ropes Course, Rock Wall & Sky Jump Waiver
* Please complete this page if your daughter may choose to participate any OR all of these activities
Please skip this page if your daughter WILL NOT participate in these activities
Participant Agreement, Release, and Assumption of Risk
In consideration of the services of Headwall Corporation, dba Squaw Valley Adventure Center, and Intrawest Corporation,
First Ascent Homeowner’s Association., Squaw Village Neighbourhood Co. and the Squaw Valley Ski Corporation, their
agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on
their behalf (hereinafter collectively referred to as “HC”), I hereby agree to release, indemnify, and discharge HC, on
behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that indoor artificial wall rock climbing, ropes course activities, hiking/snowshoeing related activities, and
the “Skyjump” activity entail known and unanticipated risks that could result in physical or emotional injury, paralysis,
death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be
eliminated without jeopardizing the essential qualities of the activity.
The risks include, among other things: the hazards of walking on uneven terrain and slips and falls; being
struck by rockfall or other objects dislodged or thrown from above; the use of climbing ropes and equipment; the
forces of nature, including lightning and rapid weather changes; the risks of falling off the rock or the course;
the risks of exposure to insect bites; the risk of cold including hypothermia; my own physical condition, and the
physical exertion associated with this activity.
Furthermore, HC staff have difficult jobs to perform. They seek safety, but they are not infallible. They might be
unaware of a participant’s fitness or abilities. They might misjudge the weather, the elements, or the terrain.
They may give inadequate warnings or instructions, and the equipment being used might malfunction.
2. I expressly agree and promise to accept and assume all of the risks existing in this activity.
My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless HC from any and all
claims, demands, or causes of action, which are in any way connected with my participation in this activity or my
use of HC’s equipment or facilities, including any such Claims which allege negligent acts or omissions of
4. Should HC or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I
agree to indemnify and hold them harmless for all such fees and costs.
I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating,
or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the
risk of any medical or physical condition I may have.
In the event that I file a lawsuit against HC, I agree to do so solely in the state of California, and I further agree
that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that
state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions
shall remain in full force and effect.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this
activity, I may be found by a court of law to have waived my right to maintain a lawsuit against HC on the basis of
any claim from which I have released them herein.
I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound
by its terms.
Signature of Participant: ______________________________________ Print Name:
Phone: ___________________________________________________ Date:
Parent’s or Guardian’s Additional Indemnification
(Must be completed for participants under the age of 18)
In consideration of ______________________________________________________________ (print minor’s name) (“Minor”)
being permitted by HC to participate in its activities and to use its equipment and facilities, I further agree to indemnify and
hold harmless HC from any and all Claims which are brought by, or on behalf of Minor, and which are in any way
connected with such use or participation by Minor.
Parent or Guardian: ______________________________Print Name: __________________________ Date: ___________
FORM 7: RELEASES & AGREEMENTS
I hereby release the American School of Dance, LLC (dba: American Dance Training Camp – “ADTC”), its officers, employees, and
agents from any and all liability, claims, demands, controversies, damages, actions and causes of action which may occur by reason
of injury, loss of services or consortium, property damage and any and all other loss and damages of any kind and nature sustained
by the camper. This release shall bind the camper, their heirs, administrators and assigns. In the event of a dispute, a cause of
action may only be brought in a court of competent jurisdiction.
Participation in dance activities involves motion in a unique environment and as such carries with it a reasonable assumption of risk.
WARNING: Catastrophic injury, paralysis and even death can result from improper conduct of the dance activity. Appreciate this
WARNING as well as the fact that, even under the best of conditions, participation in dance activities involves inherent risks of injury
on the part of the performer.
This is to certify that the undersigned have carefully read and understand the above warning statements and any and all information
contained in the ADTC brochure and/or website regarding the program in which the camper will be participating. In addition, the
undersigned further certify that the inherent risks of dance participation are adequately appreciated and that said participation is
done on a strictly voluntary basis.
Also, by signing this document, I understand that recreational activities are offered by ADTC as outlined in the ADTC brochure and
listed on the ADTC website, and that the camper may sign up for and participate in all camp activities. Participation in recreational
activities may involve motion, rotation, and physical contact with other persons and/or objects in motion and, as such, carries with it
a reasonable assumption of risk. I allow my child to participate in all camp activities, except those I did not authorize on the “optional
activities participation release of liability and assumption of risk agreement.”
TRANSPORTATION: I authorize and give ADTC permission to transport my child to camp activities/field trips.
The HEALTH HISTORY section is correct and complete as far as I know, and my child has permission to engage in all camp
activities except as noted. I herby give permission to the camp to provide ongoing health care, administer prescribed medications,
seek emergency medical treatment including ordering x-rays or routine tests, and to transport my child as necessary to seek medical
treatment. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I understand the
information on this form will be shared on a “need to know” basis with camp staff. I give permission to photocopy this form for trips
out of camp. Parent/guardian represents to the camp that the camper is in sound physical and mental health and fully able to
participate in all camp activities.
EMERGENCY AUTHORIZATION: I understand that I will be contacted as soon as possible in the event that my child is brought to
a medical clinic, hospital, orthopedist, dentist or other health care provider. In the event I cannot be reached in an emergency, I
herby give permission to the physician selected by the camp to hospitalize, secure proper treatment for, and to order injection and/or
anesthesia and/or surgery and/or any other procedure for my child deemed necessary respecting their known and disclosed medical
conditions. In addition, the camp has permission to obtain a copy of my child’s health record from providers who treat my child and
these providers may talk with the program’s staff about my child’s health status.
I herby authorize any physician, dentist, health care provider or hospital to release any information regarding the history, treatment,
x-rays or benefits payable concerning a claim to the camp or medical officer or their authorized agent for the purpose of validating
and determining further treatment or benefits payable in connection with the claim.
MEDIA RELEASE: I give permission and consent for my child to participate in all activities and to allow photographs, videos and
interviews to be taken during the camping session. I understand that the camp retains the right to use any of these photographs,
videos, or any other record of camp events for the camp’s website, publicity, advertising, or any legitimate purpose. In compliance
with COPPA (Child Online Privacy Protection Act) my signature confirms that I understand and agree that my child’s picture (without
name) may be used on publicly accessible areas of the ADTC website.
PARENT AGREEMENT & LOST PROPERTY RELEASE: I have read, understand and agree to the application/refund policies of
ADTC as well as the camp policies as set forth in camp materials. I agree to support the final decision of the directors in their
cabin/room assignment for my daughter. I release ADTC of responsibility for personal items that may be lost, stolen or damaged at camp.
Signature of Parent/Guardian
ARE Date _________________________________
Signature of Camper ______________________________________________________________
I also promise to conform to the rules and regulations of American Dance Training Camp. I understand that drinking,
smoking, the possession of alcohol or tobacco, and stealing result in immediate dismissal from camp.